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Independents' Day

A sense of community

Thirty years ago the then Secretary of State for Social Services, Barbara Castle, issued advice about community hospitals. She said: 'We have to find ways of planning patterns of services which are efficient but which retain where possible identification with each local community.'

Move forward to the parliamentary summer break last year. MPs returned to their constituencies and within the week letters were flying round from Sir Nigel Crisp asking SHAs and PCTs to sign up to financial guarantees immediately.

The net effect was that around 80 community hospitals were placed under local health management guillotines last August. Many remained in this precarious position until now. Core local services, in particular A&E units, came under close scrutiny.

But all this seems to have changed with the publication of the White Paper Our Health, Our Care, Our Community. It is proposed that the impressive sum of £150 million a year should be given to community resources, including community hospitals.

The logic is not hard to follow. Initiatives like this always reflect well on governments, and patients say what they want is to have good local accessible services.

The difficulty of course will be making it happen.

Sorting out the tariff will be vital to securing viability of local diagnostics. And the principle of timely access to tests will be fundamental to local care. The big problem will be enhancing intermediate care to look after vulnerable patients outside of tariff.

So far this has been the preserve of social services and, apart from a few shining examples, the service has been fragmented, limited in availability and sloppy.

There is no magic wand that can be waved overnight. Achieving financial balance and reducing emergency admissions will be a Herculean task.

I'm all for community services, but my fear is that a patient-led NHS will at best place a very severe strain on NHS finances and at worst will prove to be unaffordable.

There are two clear things needed if community and populist initiatives are to have any chance of success: first, we need care pathways that have health- and patient-centred outcomes as their end points; second, we need to engage the communities we endeavour to serve.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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